Clinical characteristics and prediction of Kawasaki disease unresponsive to initial dose of intravenous immunoglobulin / 中华实用儿科临床杂志

ABSTRACT

Objective To determine the prediction and clinical characteristics of intravenous immunoglobulin (IVIG) treated Kawasaki disease (KD) failure in initial dose.Methods Retrospective analysis was performed with the clinical data of 1 11 children with KD.The paticnts were divided into sensitive group and unresponsive group according to initial effect of IVIG.The clinical manifestations,laboratory examination and radiological features of the children were compared.Logistic regression analysis was performed in significant different indicators to determine independent correlation factors.In order to seek the reference indexes which indicate unresponsive to IVIG,a receiver operating characteristic (ROC) curve was made,of which the diagnostic cut-off was nine independent correlation factors while grouping was made according to patients' different responses to IVIG.Results (1)There were 90 cases (81.1％)in effective group and 21 cases (18.9％) in unresponsive group.(2) Compared with the sensitive group,hyperpyrexia cases[66.7％ (14/ 21 cases) vs 34.4％ (31/90 cases),x2 =7.334,P =0.007] and the chances of coronary artery lesions [47.6％ (10/ 21 cases) vs 23.3％ (21/90 cases),x2 =4.989,P =0.026] were significantly higher in the unresponsive group.(3)Compared with the children administered twice with gamma globulin,the children of single-dose treatment significantly reduced the unresponsive probability [12.5 ％ (9/72 cases) vs 30.8 ％ (12/39 cases),x2 =5.504,P =0.019],and there was no difference in the chances of coronary artery lesions[23.6％ (17/72 cases) vs 30.8％ (12/39 cases),x2 =0.672,P =0.412].(4)Comparing the sensitive group and the unresponsive group,the percentage of neutrophils count [(0.72 ± 0.06) vs (0.76 ± 0.04),t =-2.84,P =0.005],platelet counts [(352.38 ± 42.18) × 109/L vs (373.14 ±36.93) × 109/L,t =-2.076,P =0.040] and C-reactive protein (CRP) [(74.38 ± 12.92) mg/L vs (92.05 ± 11.17) mg/L,t =-5.780,P =0.000] were significantly higher in the unresponsive group,but the level of serum albumin[(34.09 ±3.19) g/L vs (31.61 ±2.03) g/L,t =4.442,P =0.000] was lower.(5) Multivariate Logistic regression analysis indicated that the percentage increase of neutrophils count (P =0.018),CRP (P =0.000) increase and serum albumin(P =0.040) decrease were independent risk factors for unresponsive treatment with gamma globulin.(6)After the area under the ROC curve was calculated,the percentage of neutrophils count,CRP and serum albumin could be effective predictors to IVIG treatment failure in initial dose,and the critical values were 0.72,78.5 mg/L and 33.11 g/L,respectively.Conclusions Treatment with IVIG for the first time may be ineffective in some situations such as the percentage of neutrophils count ≥0.72,CRP ≥78.5 mg/L or serum albumin≤33.11 g/L.